The possibility of smallpox bioterrorism has stimulated reconsideration of the need for smallpox vaccination and development of a vaccine that is safe and highly immunogenic. In a cohort of previously vaccinated and unvaccinated adults, Saito and colleagues assessed the immunogenicity and frequency of adverse events associated with the third generation smallpox vaccine LC16m8, an attenuated tissue-cultured vaccine. The authors found high levels of vaccine take (defined as a visible pustular lesion or area of definite induration or congestion surrounding a central lesion 10 to 14 days after vaccination) and seroconversion among vaccine-naive individuals and found that it yielded an effective booster response in a majority of persons with prior smallpox vaccination. Among the 3221 individuals in the study, there were no serious adverse events; mild events included 1 case of allergic dermatitis and 1 case of erythema multiforme.
Oseltamivir resistance among influenza A(H1N1) viruses has increased in recent years. Factors associated with oseltamivir-resistant influenza A(H1N1) virus infections are addressed in 2 articles in this issue. In the first article, Dharan and colleagues Article report demographic and clinical characteristics associated with oseltamivir-resistant vs oseltamivir-susceptible influenza A(H1N1) virus infections that were reported to the US Centers for Disease Control and Prevention during 2007-2008. The authors found that oseltamivir-resistant viruses circulated widely in 2007-2008, oseltamivir-resistant infections appeared to be unrelated to oseltamivir use, and oseltamivir-resistant cases were clinically similar to oseltamivir-susceptible cases. In the second article, Gooskens and colleagues Article report results of an investigation of nosocomial transmission of oseltamivir-resistant influenza A(H1N1) virus at a Dutch university hospital in February 2008. In an editorial, Weinstock and Zuccotti Article discuss the epidemiology and pathophysiology of influenza virus resistance and implications for influenza treatment.
Ms C, a young, undocumented immigrant from Central America, was diagnosed with leukemia during the 34th week of pregnancy. She delivered a healthy daughter at term and then received chemotherapy, which achieved remission. However, bone marrow biopsy at 6 months revealed a relapse, a second round of chemotherapy was ineffective, and she was informed that a cure was not possible. Ms C signed a do-not-resuscitate–do-not-intubate order and identified as her primary goal to spend as much time as possible with her daughter. Her partner (the child's father) requested that “everything be done” and refused to participate in end-of-life care planning. Smith and colleagues discuss challenges that Latino immigrants may face in achieving optimal end-of-life care, including separation from family, barriers to health care access, language and literacy barriers, cultural norms, spiritual beliefs, and concerns about discrimination.
Concerns about severe psychiatric events associated with the smoking-cessation drug varenicline have been heightened by an analysis of reports of adverse events that suggests a link to suicidality.
A national tobacco control agenda
Diagnostic errors—the next frontier for patient safety
Centers for Medicare & Medicaid Services rule on venous thromboembolism after hip or knee arthroplasty
Join Steven A. Schroeder, MD, March 18, from 2 to 3 PM eastern time to discuss smoking cessation in patients with psychiatric illness. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue.
Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
How would you manage a patient with poorly controlled hypertension? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is March 22.
For your patients: Information about smallpox.
This article was corrected online for error in data on 3/16/2009, prior to publication of the correction in print.
This Week in JAMA . JAMA. 2009;301(10):997. doi:10.1001/jama.2009.326